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In the previous post, we talked about how obesity is closely related to modern consumption patterns. At the same time, we talked about how obesity was proportional to the mortality rate resulting from COVID infection. While everyone knows that COVID is a pandemic, not all of us may be aware that obesity is an epidemic. The term epidemic does not only apply to infectious diseases like malaria or COVID. The definition of epidemic is “an unexpected increase in the number of disease cases in a specific geographical area”. According to World Health Organization (WHO), there is a “global epidemic of overweight and obesity … taking over many parts of the world”. They also gave a nickname to this incident, calling it “globesity”.
Overweight and obesity are terms that represent different levels along the same scale. They both define too much fat accumulation in the body which may impair health. For adults, a body mass index (calculated by diving a person’s weight in kilograms by the square of their height in meters) of 25 – 29.9 is defined as overweight and 30 or greater is defined as obesity.
WHO also mentioned that “obesity poses a major risk for serious diet-related noncommunicable diseases, including diabetes mellitus, cardiovascular disease, hypertension and stroke, and certain forms of cancer. Its health consequences range from increased risk of premature death to serious chronic conditions that reduce the overall quality of life”. This fact alone is enough to show why we should get away from obesity and overweight.
In addition, more and more children are becoming overweight or obese nowadays. This should be concerning for the parents as childhood obesity can cause their own set of problems such as precocious puberty. Such obesity can be easily found in households where parents themselves are overweight/obese, not just because of genetics but also because children eat the same things as their parents and copy the things that their parents do. Most of these cases can be controlled by close attention and care from the parents. This would involve giving less processed foods, promoting children to eat a diversity of food without being picky, and doing physical activities with them on weekends. During the weekdays, children get their physical activity requirement fulfilled at school, as they are mandated to go outside and play during recesses and lunch breaks. Taking care of the children’s weight is also a good way for the parents to take care of their own at the same time.
One may also say that it is a problem of metabolism, that they used to be slim when they were young even when they had junk food all the time. That may be true, in cases where physical activity level was quite high when they were young but not anymore. However, if they didn’t have much physical activity even back then, they should think of it this way - all of that is taking its toll now. Our body is a manifestation of what we did every day for many months and years. This can also be explained in Chinese Medicine etiology and pathogenesis. The Spleen is a major digestive organ in TCM. While there are patients who are born with weak Spleen, many develop it postnatally by overwhelming the Spleen with too much greasy, oily, sweet food, or overeating and eating irregularly in general. Spleen’s function includes transforming and transporting the nutrients into Qi and Blood, but also doing the same for fluids. Weak Spleen will fail to transform and transport fluids, which will then accumulate in our body as a harmful fluid such as Dampness and Phlegm. This Phlegm-Dampness is often visible to us as excess weight on the body.
We will look at Chinese medicine patterns that correspond to different overweight/obesity cases in more detail. In cases where one eats a lot and does not exercise, the underlying and the resulting patterns are Stomach Heat and Damp-Phlegm Accumulation, respectively. Patients with these patterns will be characterized by excessive appetite, preference for oily and sweet foods, or alcohol, and a high chance of having hypercholesterolemia and diabetes.
The second type of overweight/obese patients are those who say that they do not consume a lot but retain water easily and cannot lose weight. In those cases, the first thing they should do is to be objective and mark everything that goes into their mouth, but also their urination and defecation over a week. If they are still confident that they do not eat a lot and that they can’t lose weight even with exercise, they need to get a diagnosis and treatment for their pattern of disharmony. One of the diagnoses in these cases could be Spleen Deficiency and Failure to Transform & Transport (as mentioned above). These patients easily gain weight compared to the amount consumed and the energy spent, and urination does not feel complete/refreshing. The other possible diagnosis is Spleen & Kidney Yang Deficiency. These patients will be characterized by cold limbs, aversion to cold/easily feeling chilly, frequent nocturia (nighttime urination), and tendency to edema.
The last type of overweight/obesity patients is those who deal with mental stress by eating. These people usually have the pattern of Qi Stagnation and Blood Stasis and they frequently have accompanying cardiovascular diseases or have a high chance of developing them.
Whether one gains weight or not is ultimately an input vs. output problem. If one expends as much as they consume, they will not gain weight and if that is not the case, what remains becomes fat. If they expend more than they consume, they will lose weight. This is assuming that there is no diabetes. With diabetes, one may lose weight when they are not treated (this is not the case for everyone though) and see some weight gain again as their blood sugar level gets controlled again. Anyways, getting back to the topic, it means that one cannot gain weight without eating. At the same time, one should never “fast” if they want to lose weight in a healthy way. The same applies to intermittent fasting. Over decades, we have seen different overweight/obese patients, but none successfully lost weight by fasting in that they always came back with a yo-yo. In fact, a famous doctor in Korea showed up on TV after losing weight by intermittent fasting and they promoted the method only to show up in their original weight couple of months later. Instead of fasting, one should follow a regular lifestyle. In terms of diet, this means avoiding overeating and eating in a rush, and having a set amount of food at set times instead. In terms of exercise, it means to adopt movements that can be done at set times regardless of where one is (hence we recommend walking and free-standing exercises). In terms of scheduling these, we said it in the previous post but here is a summary of it: eat early, sleep early, and wake up early. After dinner, sleep around 3 – 4 hours later, and wake up around 2 hours before the start of work. When one eats late and falls asleep while still full of food, it can cause weight gain, acid reflux, and poor sleep quality. When one sleeps late after finishing dinner, they are more prone to being tempted by a midnight snack. When one wakes up late, they are unable to have a proper breakfast and if the lunch that follows is not sufficient either, one ends up overeating at dinner.
Below are basic principles that obese/overweight patients should follow like commandments. However, even normal weight patients should try to live their life like this in order to prevent becoming overweight or obese.
Basic Principles that Obese/Overweight Patients Should Follow:
Control of diet to consume low calorie, low sugar, and low fat foods during meal times.
Limit the intake of fat to less than 50g/day. At the same time, this fat should be primarily unsaturated fatty acids. Animal fats are prohibited – foods like pork belly, marinated chicken, deep-fried chicken, marinated ribs, processed meats, hamburger, and pizza.
For obese/overweight patients, sugars are prone to being stored as fat as opposed to being stored in the liver or muscles as an energy source. Therefore, sweet foods should be avoided. E.g.) white rice, noodles, broad beans, sweet peas, sweet potato, peanut, potatoes, apples, peaches, banana, dates, honey, chocolate, cake, breads, carbonated drinks, ice creams.
Consume bland foods and avoid too spicy, salty, or other strongly stimulating foods.
Increase the amount of exercise to inhibit fat deposition in the body. Do exercises like brisk/power walking, hiking, rope jumping, jogging. It is especially important to perform barehand/free standing exercises, or brisk walking for 1 hour after dinner.
Take caution of deep-fried foods and other oily foods as they are high in calories and they can stimulate appetite. Also, drinking alcohol increases the caloric intake due to foods that go with it, so be careful!
Beneficial foods and herbs - winter melon, cucumber, watermelon, jelly fish, dropwort/watercress, enoki mushroom, napa/Chinese cabbage, tomato, lettuce, bamboo leaves, lotus leaves, cassia seeds, hawthorn berries, rose, red sage, poria, corn silk, radish, red bean, job’s tear/pearl barley, corn, mung bean, water plantain, black bean, rabbit meat.
Reduce the supper/dinner volume. Stop eating 3 hours before going to bed.
Have a regular schedule/lifestyle.
Recommended daily caloric consumption is 1600 – 1800 kcal.
Breakfast : Lunch : Dinner caloric ratio should be 3 : 4 : 3 or 3 : 4.5 : 2.5 or 3 : 5 : 2.
The breakfast and lunch ratio may also be switched.
It should be noted that overweight/obese patients should try to lose weight gradually. It is never healthy to lose 10kg in a month. Losing weight like this can easily result in a yoyo effect because the diet method often involves radically cutting off consumption. It is recommended to lose about 1 – 2kg per month (it is a range because if body weight was quite heavy to begin with, there will be a greater weight loss within the same amount of time) and the healthy weight should be achieved over a time period of couple of years.
Remember that WHO refers to overweight and obesity as excessive fat accumulation in the body which may impair health. It is important that we should try to lose weight not only to look beautiful, but to be healthy.
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